THE Philippine Health Insurance Corporation (PhilHealth) assured accredited healthcare providers it is committed to paying claims that are without deficiencies and compliant to all pertinent policies and requirements of the program.

This was reiterated by the state health insurer amid concerns of the Private Hospital Association of the Philippines Inc. (PHAPi) over the supposed nonpayment of claims to their member hospitals, amounting to P6 billion. PhilHealth clarified that the issue was not presented in the proper perspective as the said hospital association only highlighted the unpaid portion and downplayed that a total of P25 billion had been paid in 2020.

PhilHealth said based on records, it received a total of three million claims from PHAPi member hospitals from January to December 2020, 87 percent of which had been paid, amounting to P25 billion, while 5 percent, amounting to over P1 billion, were in different processing stages.

However, about 8 percent of total claims received, estimated to cost around P2.4 billion, were either denied payment or returned to hospitals (RTH) due to deficiencies and/or violations of existing policies and guidelines. Among the common reasons of RTH were unavailability/incompleteness/inconsistency/unreadability of required documents, other documents being required, discrepancies in entries, Claim Form 2 not properly accomplished and Claim Form 4 with errors, among other causes.

On the other hand, claims are usually denied due to noncompliance to standard of care (system), filing beyond the 60-day statutory period, late refiling and non-compensable cases, among others.